Antimicrobial agents play a critical role in reducing morbidity and mortality
due to communicable diseases the world over. However, the emergence and spread
of resistance to many of these agents are negating their efficacy. Antimicrobial
resistance (AMR) threatens the effectiveness of successful treatments for
infections and is a public health issue with local, national and global
dimensions. In low-income countries, AMR frequently occurs in microorganisms
that are likely to be transmitted in the community such as those that cause
pneumonia, diarrheal diseases, typhoid fever, tuberculosis, sexually transmitted
diseases and malaria. Resistance to antimicrobial agents renders drugs for these
illnesses ineffective, resulting in the need for wide-scale use of
broad-spectrum agents, in the process creating a major global threat. Almost all
studies on the outcomes of patients with bloodstream infections demonstrate high
mortality in hospitals due to inappropriate use of antimicrobial agents.

Resistant organisms or their resistance genetic materials can be spread
widely by travellers or through contaminated goods traded internationally.
Antimicrobial resistance thus is a global challenge requiring multidisciplinary
and multisectorial efforts at national, regional and global levels. It is
possible to minimize the spread of antimicrobial resistance through adopting
approaches such as combination therapy, rational prescription of medication,
patient adherence to prescription regimen, strong regulatory mechanisms, and
educational activities, along with creating an efficient surveillance system.
This is feasible through strong national monitoring programmes that aim to
detect the emergence and spread of resistant strains. A number of initiatives
have been launched by the WHO Regional Office for Africa and other agencies to
combat the growing threat of AMR.

Members States in the WHO African Region endorsed the Integrated Disease
Surveillance and Response (IDSR) strategy in 1998 and recommended the
implementation of the International Health Regulations (IHR 2005) in the
framework of IDSR. Effective implementation of IDSR will strengthen networks of
public health laboratories and thus contribute to effective monitoring of
antimicrobial resistance.

Accurate, reliable and timely laboratory testing is an essential component of
effective disease prevention and management. High quality AMR testing is
essential for clinicians to make accurate diagnoses, formulate treatment plans
and subsequently monitor the effects of treatment. It is also important to guide
national policies and treatment guidelines according to the national AMR
patterns. Improving laboratory-based surveillance of AMR is a key component of
health system strengthening and is critical to the enhancement of health care
delivery and disease prevention and control. In addition, the WHO Global
Strategy for Containment of Antimicrobial Resistance recognized laboratory-based
surveillance of antibiotic resistance as a fundamental priority for the
development of strategies to contain antibiotic resistance and for assessment of
the impact of interventions.

To contribute to the improvement of surveillance of antimicrobial resistance
at the country level, the WHO Regional Office for Africa has developed this
guide to facilitate establishing of laboratory-based surveillance for priority
bacterial diseases in the WHO African Region.